Provider Demographics
NPI:1154328292
Name:CASTILLE, THOMAS A (MD)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:A
Last Name:CASTILLE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:703 E PRUDHOMME ST
Mailing Address - Street 2:
Mailing Address - City:OPELOUSAS
Mailing Address - State:LA
Mailing Address - Zip Code:70570-6494
Mailing Address - Country:US
Mailing Address - Phone:337-942-7192
Mailing Address - Fax:337-942-5940
Practice Address - Street 1:703 E PRUDHOMME ST
Practice Address - Street 2:
Practice Address - City:OPELOUSAS
Practice Address - State:LA
Practice Address - Zip Code:70570-6494
Practice Address - Country:US
Practice Address - Phone:337-942-7192
Practice Address - Fax:337-942-5940
Is Sole Proprietor?:No
Enumeration Date:2005-07-05
Last Update Date:2010-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA015124208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1339601Medicaid
LA020049853Medicare PIN
LA5L424C679Medicare PIN
LAB61311Medicare UPIN
LA1339601Medicaid